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538 Baltimore Rd i , � . � � DAVIE COUNTY ENVIRONMENTAL HEALTH ', ' � P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT Accou,it #: 990003057 Tax PIN/EH #: 5861-83-0073 Bilied To: Hope Contracting, Inc. Subdivision Info: ,J3� Reference Name: Location/Address: Baltimore Road-27006 Proposed Facility: Residence Property Size: .86 Acre � ATC Number: 4893 L p� G 0—� � �r�5 yJt7�� ' � � �C�l'v0 n�S' **NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. __. / �y I� � �� ��� System Type: _._S.T.Manufacturer �1(�, Tank Date J Tank Size O� Pump Ta � '� �,,�,. ,�+-� D�:� . _� - Q-a System Installed By: E.H.Specialist: Date:�_ �J� ���� Q d� G :dv�..c7v.�. d� ��� � � v¢ �v � , � J � � . � '���,� � -�� � � , �� ��. � �� � � � Q 3� 1� y� � , ,� �� '� . , ,�� � t5� . DCHD 11/06(Revised) , � , ` . ,. . r ' DAVIE COUI�TTY ENVIRONMENTEIL HEALTH /�,� � ital Street �/ � P.O.Box 848/210 Hosp � O 2 � Mocksville,NC 270 8 n t� (336)751-8760 Fax#(336)751--8786 "4h AUTHORIZATION FOR WASTE�VATER SYSTEIVI CONSTRUCTION Account #: 990003057 � Tax PIN/EH#: 5861-83-0073 Billed To: Hope Contracting, Inc. Subdivision Info: Reference Name: ` Location/Address: Baltimore Road-27006 Proposed Facility: Residence. Property Size: .86 Acre ATC Number: 4893 Site Type: SNew ❑Repair ❑Expansion *�NOTE**This Authorization to Constnict(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building pemut(s),(in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specifications: #Bedrooms�#Bathrooms�#People Basement❑ Basement plumbing0 Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size_Q.Q�(t�x! Type of Water Supply: QCounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD)��d Tank Size�.�AL.Pump Tank��GAL. � �� �. �� � ' � /� / Trench Width 31/ Max.Trench Depth 3� Rock Depth__��__ Linear Ft. y�J� SiteModifications/Conditions/Other: �, ).e ���,�)��{o �� `��F' �-P�C�I/�v ��<<��Ol��e[s' .4dt�Ol/ '� ���c Contact the Davie County Environmental Health Section for final inspection of this system be veenn I� �� 8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760. 1✓��� Ce � �1� l,�a'�'3 ' � ��1 G`� c�� 3� 3G' r�����✓ �- . �� � �r`�� � � --_ _D � ,�w, st�ted in 15� NCAC 1�A.19�9(5� �ccepted Systems may also be use � � �°�-� _ E�vironmental Health Specialist ,�""` � � �� Date: /� - nrurl t 1/n�!17 P.,;�Arll � . ' • • � , • ' . Davie County Environmental IIealth P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 Account #: 990003057 IMPROVEMENT P��'N/EH #: 5861-83-0073 Billed To: Hope Contracting, Inc. Subdivision Info: Address: 342 Kingsmill Drive Location/Address: Baltimore Road-27006 City: Advance Property Size: .86 Acre Reference Name: Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans,plat or the intended use change. Pemut Type: �ew �Repair �Expansion Pernut Valid for: Years ONo Expiration Residential Specifications: #Bedrooms�#Bathrooms � #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): ��� Type of Water Supply: C�'County/City ❑Well ❑Community Well Site Modifications/Permit Conditions: S stem T e LTAR Initial Re air SitePlan f ' ' � � ��( �` � ��,��1,u �l �U �T Q\ � � ��� � � � �� ��� ,,� �� : � ��dG ,� �'`� �`�� �—� � v�,r v � � ���� v .� � �� � � � J � � � � � b.-� 7z`" �P`� �-" � �C � ' � � � � D�,���y � � � ✓ . � � � ��� r uv Environmental Health Specialist ' Date � r � , ,, . ' ' ' . npr�ca uo ue:a�p aavie couno� envneaicn �ab �at aiao p.e � . � - APPLICATION FOR STTE fiVALUATION/I1��Il'ROVEMEN f P A�� � (� �n Davie County$ealth L►epartment u V � � Environmental Healt�i Section P.O.Boz 848/210 Hospital Street � ��� � z ,4 : Mocksville,NC 2"028 �OO$ ��,, (33�751-8760/Fax(336)751-8786 `^�"' Application For CJ Sit�Evalhation/Lnprovemeat Pennit ❑Authori raiion To Conmuci(A1'C) ❑Both ���RONNE�v Tq�f,��rJ� DA'✓1�CCi';V;' "�'•IhIPORTAM'�"�THIS APPLIC,ATION CANNOTBBPROC,�SSED UNLESS AY.T.OF Ti�REQUIItED INFORMATTON IS PRO�/IDED.l�cfer m thc II�'ORMAZTON IIULI.1:fII�T foi iasavctions. APPLICANT INFORMATION Name to be Dill-.������� � �n/ C•�nt2ct Petson�o.y�� �"TO p e. (\„ $iUiag Add�ss �t •/ l3omc Phoue O CitY/Sta�e/'L� /�'Idl�-✓�� D B�isiness Phone_ D S� ' ) Name on Prntut/ATC ifDifjerer.t than Above MailingAddztss City/5tate/Zip � ' � PROPERTY INFOKMATTON � � IdOTE: A s�ttvey piat o�sitc plaa xa�st acCompany this applicatiaa (Pemnt is id for 60 amoailt:with site p]aq ao expiratian wt cwnplete plat) StreetAddress P /Q d Ciry . a� A/Y� Tax PIN#,��ID�S�3OC�,?3 � � � SubdivisionNazna SectionlLot# — LotSize . C\V ' tions To Site: O :M �� '�- o ' �r n\ t�, ti — .S � ",.- /Z d r� i � � � Date HousrJFacility Comers Flagg� // �1.+� —D / ' N IFtfie eaawet to any of the fnAowiub questions is`�es",su�poitiq,doc�eo6ticm rtncst lx suaclu�d. Ate thero azry existiog wastcwate[systenu on the site? �OAio � c � Dou the six contaia jurisdieionai wGlands? DY�a OY�o . Are there aay eascmenu or riFbt-of-ways oa ihe site? ❑Y�s 0T� ppp,,, Is thc site subject to appmvtil'ry�tiut pttblic agency�? �Y�Y II to � �,'� Will wastcwatec other than do:oestic sewage ba geacxatod? LiYi s� (') IF RESIDENC�?FILL OUT TfiI;BOX BEIAW � � #Pwpin #Bedre�oms�,_ #Batbrooms�Gardenh�b/Whirlpool�Yes ONo _ Basement�Yes •�2dS BaseiuentPlu:nbin� OYes L3Nir rn Nor�x�sm�rrrres�ua.our�Box a�.ow � � Zype of FacilitylBusiness Total Squaore Fooh.ge of Building #People \� � #Sinls #Coaanode.v #Showas #Urinals � � �sUmated Water Lsaga{gallons pd'day) (Attach doci mtntation of similar facility watcr coasump tion) FOODSERVICE ONLY: #Seafs Type SYsLeainqneste.�d: RConvmtioua DAceepted Dinnovativa ilAltcrwtive ❑Odia ,S� � `�� � � Walez Sugp1Y'I�pe:.7 t:ouaty/City Waler ❑I�ew WeII OH�asling Wetl C]Cummuniry Well � C Do yWlBnficipale additioa5 ar expaatio�of the fa�a7ity this system is iuteod��to save?�Ycs efNo � If yes,wbat type? _ This is to aitiCy tLat the infonmation�inavided on fhis application is true and:ouect to the best of iuy knowledge. I understand that aqy Pcmmt(s)or ATC�s)issaed HereaiLe:are subject ro snspeasion or revocab on ifthe site is al�recl,the intended use ctsangcs,or if the infozmatiaa submiKod'm t6is applicttioa is IaLtified or c2waged. I uxd�s cnd thet I mn responxibfe for all charger inarrred from rhi,r ap,plication 7 hereby grant rig ht of enhy to d�e Anthoriud Repnseatarive of the Favie Couruy Health Depazt�aeat to conduct aecessary inspa�oas to d�t ' e mpliaaa 'th ap licable Iaws:md rules on the abovr descn'bed property Iocateci in ' Davie County and oqaed by , Site Revisil Charge I'ropaty ow�r's or owner's legai rep�:wtative signamre Dutc(s):_ �—�`(�� Client Notification Date: Date �' Sign givca QY�s ONo A cwunt# �� R�y�„�y06 lavoice# � _ _ _ _ _ _ Reports Page 1 of 1 �; , Davie Cou�ty, NC . � . - - r �" +� ' .'. '� '� M ' I _� •' , ,�_�,� �� '� - -�. r,�� �, „� a�-� � 1 - ,I �... i ,. . Y 1 -�-1. b� ai �- � �...3�..:...�m. 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E70000012t � � ,�reUa,�u ioi l't�ie invcnlciy oi ��V� PIN Number. 5861830073 -� I �,� property found within this O -�� F jurisdiction,and is compiled from ccount Number: 000037692000 recorded deeds, plats, and other publ�: �, •, � Listed Owner#1: HOWARD VELDA INEZ ,. records and data. Users of this map arc OU N�C Listed Owner#2: hereby notified that the aforementionc : Mailin Address 1: 1731 CORNATZER ROAD public primary information sources shc _ be consulted for verification of the Mailin Address 2: I informatioi�contained on this map. TI Cit : MOCKSVILLE I County and mapping company ass� _ State: NC legal responsibility for the inform contained on tl ;. , ,_ Zi Code: 27028 Legal Description: LOTS 20-27 B R RMSWORTHY crea e: 0.86000000 Deed L`ate: 019830110 I Deed Book and Pa e: OOli.80335 � Plat Book: 0003 � i Plat Page: 082 � Buildin Vatue: 0 Outbuilding and Extra 3800 Features Value: Land Value: 24570 otal Market Value: 28370 otal Assessed Value: 28370 hitp://maps.co.davie.ne.us/UoMaps/reportsheport.cfm?CFID=30171&CFTOKEN=96803875 7/8/2008 �, � ; - -- -- ---- — — --- --- -- - —— --I' / �. oa � rj�� '� ` � � � � ' � •� � � �� ---� i 1 � ' � _ ' __ t � � � �-�- , � � � � _ �. ,�.Q �� �0�S� � � - �, � bo � . �. W�� � � � � � � a _ y � , � � � , � � _ . � � � � ' , � � � �.— e � .� , , ' DAVIE COUNTY HEALTH DEPARTMENT " '` � . ' Environmental Health Section a ` Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003057 Tax PIN/EH#: 58618�73 Billed To: Hope Contracting, Inc. Subdivision Info: Reference Name: Location/Address: Baltimore Road-270QS � � � Proposed Facility: Residence Property Size: .86 Acre Date Evaluated: l� � ''� Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit (I��� � �� Cut FAC'TORS 1 2 p,' ��' 4 5 6 7 Landsca e osition L Slope% '1- HORIZON I DEPTH - I G- / Texture grou G C Consistence � �!�� Structure a ' (� d5r k �}�/ S Mineralo , .e i �� �( HORIZON II DEPTH I. -3 G �-- Texture rou ' � SG Consistence `f,r '/ Structure E � /,� ,e �/r Mineralo �Pc q. ,t / HORIZON III DEPTH G - �— � � - c/ Texture rou �b:,-L -Ci.� Consistence " � Structure t i� C l� L 4"�' Mineralo ^ � � j� HORIZON IV DEPTH Texture rou Consistence Structure '� t% Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE Cz CLASSIFICATION LONG-TERM ACCEPTANCE RAT , SITE CLASSIFICATION: EVALUATION BY: , LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: � REMARKS: LEGEND � T.andscape Position . R-Ridge S -Shoulder L-Linear slope FS -Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope Tcxttug S -Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt SICL- Silty clay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay ('ON4IST+.N . �. �Isist VFR-Very friable FR-Friable FI-Firm VFT-Very firm EFI-Extremely firm � NS -Non sticky SS-Slightly sticky S-Sticky VS -Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic StT.ur.tu�e SC- Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogv 1:1,2:1,Mixed 1Y9�� Horizon depth-In inches Depth of fill-In inches Restrictive horizon-Thickness and inches from land surface Saprolite-S(suitable),U(unsuitable) Soil wetness-Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification-S(suitable),PS(provisionally suitable),U(unsuitable) rT�n r .._.. ......... ..,....._.,._..__^•- --u�---ir.n �..__�